Week 2 - Upper & Lower Quarter Scan Flashcards by Henry Scholz

What is the 1st of the 5 key components of patient managements performed by the physical therapist?

Examination

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What is the first component of Systems Review that you will always perform as part of the examination process?

Upper or Lower Quarter Scanning

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According to the Regis HOAC model, what are the 5 main components of patient management?

Examination
Evaluation
Diagnosis
Prognosis
Problem List and Goals (Intervention & Outcomes)

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According to the Regis HOAC model, what are the 2 components of Examination of patient management?

History & Review of Systems

2. Data Gathering

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According to the Regis HOAC model, of the 2 components of Examination, is History & Review of Systems:

a. Listening
b. Hands-on

a. Listening

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According to the Regis HOAC model, of the two components of Examination, is Data Gathering:

a. Listening
b. Hands-on

b. Hands-on

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According to the Regis HOAC model, what are the 6 components of the History & Review of Systems component of Examination?

Clients Health Condition
Referral Information
Chart Information
Family History
Patient Identified Problems (PIPs)
Review of Systems

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According to the Regis HOAC model, what are the 2 components of the Data Gathering of Examination?

Systems Review

2. Tests & Measures

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What are the 4 purposes of the UQ or LQ Scanning Examination component of the Systems Review?

Identify major area(s) of involvement if patient/client cannot delineate.
Eliminate confusing or conflicting information provided by the patient.
Assist in delineating the source of the problem or complaint to a single area or region.
Rule out referred pain or symptoms from another body system or region.

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If a patient says that they have both shoulder, elbow, and hand pain, under which purpose is the Scanning Examination component of the Systems Review helpful?

Eliminate confusing or conflicting information provided by the patient.

We can use the Scanning Examination to determine if indeed movements or stresses apply to the shoulder, elbow, or hand indeed reproduce the patients systems.

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If a patient is complaining of hand pain, but their pain is actually coming from the cervical spine region, under which purpose is the Scanning Examination component of the Systems Review during Examination helpful?

Rule out referred pain or symptoms from another body system or region.

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T/F: We must perform a Scanning Examination on every patient we see, therefore is must be done as quickly and efficiently as possible.

True

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What are the 3 components of the Scanning Examination of Systems Review?

Observation
Spine & Extremity Mobility Assessment
Strength & Nerve Level Assessment

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During the Observation component of the UQ or LQ Scanning Examination, what are the 3 assessments?

Posture Assessment
Skin Integrity
Functional Movement Assessment

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What is the Strength & Nerve Level Assessment often referred to as?

Myotome Testing

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What are we doing when we perform a Strength & Nerve Root Level Assessment?

Assessing strength of KEY muscles of each nerve root level.

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What Procedure is is used during a Strength & Nerve Root Level Assessment of Scanning Examination?

use Manual Muscle Testing Procedure

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T/F: During a Strength & Nerve Root Level Assessment, muscles are assesses unilaterally.

False: Asses muscles BILATERALLY

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What are the 2 ways in which a muscle response is graded during a Strength & Nerve Root Level Assessment?

2. DIMINISHED

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If during a Strength & Nerve Root Level Assessment a muscles strength is graded as WNL, what does thing mean?

Within Normal Limits

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How is the Functional Movement Assessment of during the Observation component of the Scanning Examination important to a PT? (2)

As PT’s we assess functional movement patterns through observation & determine the contribution of multiple body parts to the overall movement pattern.
In addition to assessing movement pattern, can help delineate the possibility of Regional Interdependence.

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What is Regional Interdependence?

the determination of whether seemingly unrelated impairments in a remote anatomical region may contribute to, or be associated with the patients primary complaint.

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A patient has a primary complaint of knee pain, we ask them to do a squat and we notice that they have restricted knee range of motion. If we follow the concept of Regional Interdependence, what might be find?

what we need to do know is look to see if they have normal movement in the hip, and normal movement in the foot and ankle. It could very well be that an impairment in hip movement or ankle movement, whether is be soft tissue or bony, is what actually is causing the restriction in knee range of motion, and is leading to the patients complaint of pain in the knee.

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When doing the Skin Integrity assessment during the Observation component of the Scanning Examination, what should 1st be done and what 4 things do we check for?

1st should expose as much of skin as possible.

Check for

Edema
Bruising
Areas of Redness
Temperature Changes

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When doing the Functional Movement Assessment during the Observation component of the UQ Scanning Examination, in the upper quarter which functional movements do we look at? (4)

1. Hands behind the back 2. Hands behind the neck 3. Comb Hair 4. Bring cup to mouth

When doing the Functional Movement Assessment during the Observation component of the UQ Scanning Examination, why do we look at Bring cup to mouth?

Incorporates elements of pronation of the forearm and flexion of the elbow.

When doing the Functional Movement Assessment during the Observation component of the UQ Scanning Examination, why do we look at Hands behind back?

Mobility of the scapulo-thoracic, shoulder, elbow, hand, and wrist

When doing the Functional Movement Assessment during the Observation component of the UQ Scanning Examination, why do we look at Hands behind the neck?

Mobility of the scapulo-thoracic, shoulder, elbow, hand, and wrist

Once we have completed the Observation component of the Scanning Exam, what do we move onto next?

Spine & Extremity Mobility Assessment

For the Upper Quarter Scan, what areas do we look at during the Spine & Extremity Mobility Assessment? (4)

1. Cervical Spine 2. Shoulder 3. Elbow/Forearm 4. Wrist

What motions do we look at during the Upper Quarter Scan of Spine & Extremity Mobility Assessment for the Cervical Spine? (4)

1. Flexion 2. Extension 3. Lateral Flexion 4. Rotation

What motions do we look at during the Upper Quarter Scan of Spine & Extremity Mobility Assessment for the Shoulder? (5)

1. Flexion 2. Extension 3. Hyper-extension 4. Abduction 5. Rotation (Internal & External)

What motions do we look at during the Upper Quarter Scan of Spine & Extremity Mobility Assessment for the Elbow/Forearm? (4)

Elbow 1. Flexion 2. Extension Forearm 1. Pronation 2. Supination

What motions do we look at during the Upper Quarter Scan of Spine & Extremity Mobility Assessment for the Wrist? (4)

1. Flexion 2. Extension 3. Ulnar Deviation 4. Radial Deviation

What 2 things do we look during each motion of each area of the during the Spine & Extremity Mobility Assessment?

1. Full ROM | 2. Pain/Symptom Free

During the Spine & Extremity Mobility Assessment, if a patient has full ROM & pain/symptom free, how do we clear this specific motion?

Add a slight amount of over-pressure at end of range. If patient is still pain/symptom free then this motion is cleared.

During the Upper Quarter Scan of Spine & Extremity Mobility Assessment, how do you apply over-pressure for Rotation of the Cervical Spine?

Use elbow to block the shoulder from moving.

You are performing ulnar deviation on a patients wrist during the Upper Quarter Scan of Spine & Extremity Mobility Assessment. The patient indicates they have no pain or symptoms moving through the specific ROM. What should you do next?

Apply over-pressure at the end of the patients available range and again check for pain or symptoms.

During an Upper Quarter Scanning Exam, once you complete the Spine & Extremity Mobility Assessment what do you do next?

Strength & Nerve Root Level Assessment

Which of the 3 components of the Scanning Examination asses the strength of muscle groups that are reflective of certain nerve root levels?

3. Strength & Nerve Root Level Assessment

During a Upper Quarter Strength & Nerve Root Level Assessment, what Nerve Root Level is associated with Neck Flexion?

C1-2

During a Upper Quarter Strength & Nerve Root Level Assessment, what Nerve Root Level is associated with Neck Lateral Flexion?

During a Upper Quarter Strength & Nerve Root Level Assessment, what Nerve Root Level is associated with Shoulder Shrug?

During a Upper Quarter Strength & Nerve Root Level Assessment, what Nerve Root Level is associated with Shoulder Abduction?

During a Upper Quarter Strength & Nerve Root Level Assessment, what Nerve Root Level is associated with Elbow Flexion OR Wrist Extension?

During a Upper Quarter Strength & Nerve Root Level Assessment, what Nerve Root Level is associated with Elbow Extension OR Wrist Flexion?

During a Upper Quarter Strength & Nerve Root Level Assessment, what Nerve Root Level is associated with Thumb Abduction?

During a Upper Quarter Strength & Nerve Root Level Assessment, what Nerve Root Level is associated with Finger Abduction?

During a Upper Quarter Strength & Nerve Root Level Assessment, what Movement is associate with Nerve Root Level C1-2?

Neck Flexion

During a Upper Quarter Strength & Nerve Root Level Assessment, what Movement is associate with Nerve Root Level C3?

Neck Lateral Flexion

During a Upper Quarter Strength & Nerve Root Level Assessment, what Movement is associate with Nerve Root Level C4?

Shoulder Shrug

During a Upper Quarter Strength & Nerve Root Level Assessment, what Movement is associate with Nerve Root Level C5?

Shoulder Abduction

During a Upper Quarter Strength & Nerve Root Level Assessment, what Movement is associate with Nerve Root Level C6?

Elbow Flexion or Wrist Extension

During a Upper Quarter Strength & Nerve Root Level Assessment, what Movement is associate with Nerve Root Level C7?

Elbow Extension OR Wrist Flexion

During a Upper Quarter Strength & Nerve Root Level Assessment, what Movement is associate with Nerve Root Level C8

Thumb Abduction

During a Upper Quarter Strength & Nerve Root Level Assessment, what Movement is associate with Nerve Root Level T1?

Finger Abduction

How does Lower Quarter Scanning Exam differ from Upper Quarter Scanning Exam?

Where we begin the Functional Movement Assessment will depend on the patients status, non-weight bearing or weight bearing.

If a patient has non-weight bearing status and has Bed Mobility, what exercises can be performed? (3)

1. Bridging 2. Rolling to Side 3. Supine-to-Sit

If a patient is has weight bearing status and can perform Function Activities, what exercises can be performed?

1. Step-up 2. Ste-down 3. Squatting 4. Sit-to-Stand

What is the final element of the Functional Movement Assessment for Lower Quarter Scanning?

Gait Analysis

During a Gait Analysis for Functional Movement Assessment for Lower Quarter Scanning, what are 2 irregularities that we can look for?

1. Antalgic (painful) pattern | 2. Trendelenburg

For the Lower Quarter Scan, what areas do we look at during the Spine & Extremity Mobility Assessment? (4)

1. Lumbar Spine 2. Hip 3. Knee 4. Ankle

What motions do we look at during the Lower Quarter Scan of Spine & Extremity Mobility Assessment for the Lumbar Spine? (5)

1. Flexion 2. Extension 3. Lateral Flexion 4. Rotation 5. Quadrant

What motions do we look at during the Lower Quarter Scan of Spine & Extremity Mobility Assessment for the Hip? (3)

1. Flexion 2. Abduction 3. Rotation

What motions do we look at during the Lower Quarter Scan of Spine & Extremity Mobility Assessment for the Knee? (2)

1. Flexion | 2. Extension

What motions do we look at during the Lower Quarter Scan of Spine & Extremity Mobility Assessment for the Ankle? (4)

1. Dorsiflexion 2. Plantarflexion 3. Eversion 4. Inversion

Rotation vs. Quadrant testing of Lumbar Spine

Rotation: Rotate while we stabilize the pelvis and we do not apply over-pressure. Quadrant: Reach to back of leg and slide their arm down the hamstrings to the crease of their knee and apply over-pressure if no symptoms.

During a Lower Quarter Strength & Nerve Root Level Assessment, what Nerve Root Level is associated with Hip Flexion?

L2-3

During a Lower Quarter Strength & Nerve Root Level Assessment, what Nerve Root Level is associated with Knee Extension?

L3-4

During a Lower Quarter Strength & Nerve Root Level Assessment, what Nerve Root Level is associated with Ankle Dorsiflexion OR "walking on heels"?

L4-5

During a Lower Quarter Strength & Nerve Root Level Assessment, what Nerve Root Level is associated with Great Toe Extension?

During a Lower Quarter Strength & Nerve Root Level Assessment, what Nerve Root Level is associated with Single-leg Standing Toe-Raises OR "walking on toes"?

L5-S1

During a Lower Quarter Strength & Nerve Root Level Assessment, what Nerve Root Level is associated with Ankle Eversion?

S1-2

During a Lower Quarter Strength & Nerve Root Level Assessment, what Movement is associate with Nerve Root Level L2-3?

Hip Flexion

During a Lower Quarter Strength & Nerve Root Level Assessment, what Movement is associate with Nerve Root Level L3-4?

Knee Extension

During a Lower Quarter Strength & Nerve Root Level Assessment, what Movement is associate with Nerve Root Level L4-5?

Ankle Dorsiflexion OR "walking on heels"

During a Lower Quarter Strength & Nerve Root Level Assessment, what Movement is associate with Nerve Root Level L5?

Great Toe Extension

During a Lower Quarter Strength & Nerve Root Level Assessment, what Movement is associate with Nerve Root Level L5-S1?

Single-leg Standing Toe-Raises OR "walking on toes"

During a Lower Quarter Strength & Nerve Root Level Assessment, what Movement is associate with Nerve Root Level S1-2?

Ankle Eversion

How long should a scanning examination take you?

6-8 minutes

What are the 5 systems examined during the Systems Review?

1. Cardio/Pulmonary 2. Integumentary 3. Musculoskeletal 4. Neuromuscular 5. Communication Ability

What are the 2 components of the Systems Review of the Data Gathering portion of the Examination?

1. Physiologic Monitoring | 2. Upper Quarter or Lower Quarter Scanning Exam

What are the 4 reasons for selecting test and measures and examples?

1. To Assist in confirming or rejecting proposed hypothesis - Lachman test for the knee - ACL Injury 2. To confirm or document an impaired Body Structure or Function - Muscle Strength Deficit - MMT 3. To guide or direct treatment - Joint Play Assessment 4. Use as an intervention Outcome Measure - Goniometry - document improved ROM